EXPATRIATE TAX QUESTIONNAIRE FOR U.S. CITIZENS LIVING ABROAD
Don D. Nelson, CPA, Attorney / Charles Kauffman, CPA / Kauffman Nelson LLP
This questionnaire can be filled out by hand or in MS Word
Indicate year this form is completed for - if not 2016:______
Primary Taxpayer Spouse (write N/A if not married)
Name ______
Social Security Number ______
Date of Birth ______
Profession ______
Citizenship Country ______
U.S. Green Card Holder? ______
Indicate if Green Card obtained or relinquished this year and date
If the IRS sent you info relating to an Identity Protection PIN “IP PIN” please send us the information. It is an alternative number to a SSN that the IRS has issued in certain cases. If you are not familiar with this, you likely do not have one and no action is required.
Did you file a joint U.S. return with your spouse last year? _____ Yes _____ No _____N/A
Did your marital status change this year? _____ Yes _____ No _____N/A
Indicate any U.S. States where you filed a tax return last year: ______
Might you be required to file an additional return with a US state as well? ____Yes____ No ____Don’t know
-Please Explain.______
Contact Information
Email Address(es) ______
Phone Numbers (indicate home,
office, or mobile) ______
Residence Address in Foreign Country ______
Mailing Address to be shown on
Tax Return ______
If a U.S. address, please indicate c/o and Name if mail is going to someone else
Best time or method to contact ______
Dependent Children(s) Names, Gender of Child, Dates of Birth, and Social Security Numbers:
Please note if your children are not U.S. citizens and their country of citizenship. Also please note if your children have earned income, investment income, are married, or are not residing with you as the custodial parent. Also indicate if you have dependents other than children that are U.S. citizens or residents. Attach extra sheet for answers if needed.
1. Date you arrived to live & work in your foreign residence country: ______
2. Are you still a resident of the Foreign Country? _____ Yes _____ No
3. If not, what date did you return to the U.S. to take up residency and
to which state did you move?______
4. If you have previously filed Form 2555/2555EZ (foreign earned income
exclusion) with your return, what was the last year you filed this form? ______
If you were present in the U.S. or U.S. possessions during the calendar year in question, please fill in the following information for each trip to the U.S. (attach additional sheet if necessary):
Date Arrived in U.S. / Date Departed U.S. / Income on days worked in U.S. (indicate the state) / Employer’s Name$ ____State
$ ____ State
$ ____ State
If you moved to or from the U.S. this year you may need to qualify under a 330 day physical presence test. In that case, we need a schedule of all U.S. trips through today’s date
NOTE: You can use http://www.oanda.com/currency/converter/ for historical currency conversions (typically average exchange rate for the year is used). IRS also publishes average yearly rates here: http://www.irs.gov/Individuals/International-Taxpayers/Yearly-Average-Currency-Exchange-Rates
PRIMARY TAXPAYER EARNED INCOME INFORMATION:
5. Employer’s Name and Foreign Address: ______
6. Employer’s U.S. office address (if any): ______
7. Employer is a ____Foreign Company _____ U.S. Company _____Foreign Subsidiary of a U.S. Company
8. Gross wages/salary earned in foreign country for calendar year in US Dollars: ______
9. Foreign Income Taxes paid for Calendar tax year on your salary in US Dollars: ______
10. Indicate currency in which foreign wages/taxes are paid and exchange rate you used: ______
11. If applicable, is all income on a Form W-2 issued by a U.S. company? ______Yes ______No
SPOUSE’S EARNED INCOME INFORMATION:
12. Employer’s Name and Address: ______
13. Employer’s U.S. office address (if any): ______
14. Employer is a ____Foreign Company _____ U.S. Company _____Foreign Subsidiary of a U.S. Company
15. Gross wages/salary earned in foreign country for calendar year in US Dollars: ______
16. Foreign Income Taxes paid for Calendar tax year on your salary in US Dollars: ______
17. Indicate currency in which foreign wages/taxes are paid and exchange rate you used: ______
18. If applicable, is all income on a Form W-2 issued by a U.S. company? ______Yes ______No
NOTE: In some countries (U.K., Australia, Hong Kong) the normal tax year is a fiscal year (such as April 6 to April 5). However, all income, deductions, and tax credits must be reported on a Calendar Year Basis (Jan 1 to Dec 31). Therefore it may be necessary to adjust your foreign fiscal year income/taxes from your foreign tax return to the correct calendar year amount acceptable by the IRS.
IMPORTANT: There is no foreign income exclusion allowed for calculating Self Employment Taxes (FICA/Medicare) – unless you live in a country that has a Social Security Agreement/Treaty with the U.S. (countries can be found here: http://www.socialsecurity.gov/international/agreement_descriptions.html) and are paying the equivalent social security tax in that country. If applicable, a certificate from that country may be required. If self-employed you will owe the U.S. self-employment social security tax on your net business income (approx. 15.3%) unless you are covered by one of these agreements.
19. Were you or your spouse self-employed or independent contractors in the foreign country? / _____ Yes _____ No20. Type of Business
21. Business Name
22. EIN Number, if any (US ID number)
23. Ownership / _____ Husband _____ Wife _____ Joint
If self-employed in business, please complete a statement of income and itemized expenses for the business for this calendar year and attach the statement to this packet. You may request our self-employment questionnaire supplement). List totals below:
24. Total gross business income for tax year in USD / $25. Total business expenses for tax year in USD / $
26. Do you rent or own your residence overseas, or is it provided by employer? ____ Rent ____ Own
_____Provided by Employer
27. If employer provided housing, amount paid by employer or value of housing provided: $______. Is this housing amount already included in the salary figure you provided in question #8? ___Yes __No
28. Total Rent and Utilities paid on foreign residence, other than telephone: ______
29. Indicate family members living with you overseas and for what period: ______
30. Are you required to pay income taxes in the foreign country? _____ Yes _____ No
31. What type of Visa do you hold for your resident country?______
US EMPLOYMENT EARNED INCOME: If you moved to a foreign country during this year or moved back to the U.S. during this tax year please complete this question relating to your period of U.S. employment:
32. Employer Name and Address (if self-employed indicate and attach a list of income/expense for the U.S. period of time): ______
33. Occupation: ______
34. Income: ______
35. Period of time working for this employer:______
36. W-2 attached? (provide W-2 breakdown if available)______
RENTAL INCOME AND EXPENSES
If you own rental property in the U.S. or abroad, please attach a sheet showing all income and summarized expenses for the year. If we did not do your return last year, we will also need the date the rental began, amount paid for property, amount allocable to land, any major improvements, and a copy of the previous depreciation schedule if previously depreciated. (Ask us for a rental property questionnaire if you need to give us this data and it will be e-mailed to you).
Indicate how many properties you have rented out or had available for rent this tax year, if any. Please provide locations of properties and describe the rental activities.37. Do you maintain a U.S. home while living abroad? If so, provide address: _____ Yes _____ No
______
38. If your U.S. residence is occupied indicate who is living in the residence,
their relation, and whether this residence is rented out: ______
______
NON-EARNED INCOME (Attach separate sheets if additional space needed for any items)
Interest Income, including on non-US bank accounts (Indicate currency if not listed in USD):
Description/Payor / Location of Payor if not U.S. / Ordinary Interest / US Tax Exempt Interest / Foreign Taxes Paid$ / $ / $
$ / $ / $
$ / $ / $
Dividend Income (Indicate currency if not listed in USD):
Description/Payor / Location of Payor if not U.S. / Ordinary Dividend / Qualified Portion / Capital Gain Distribution$ / $ / $
$ / $ / $
$ / $ / $
If there were foreign taxes withheld from any please provide further information.
Capital Gain Income (Stock or property sales – include any statements):
Description / Country / Date acquired / Date Sold / Sales price / Original cost plus purchase fees$ / $
$ / $
$ / $
If there were foreign taxes paid on or U.S. taxes withheld from these transactions let us know. Also ensure you have indicated the currency accurately if not U.S. Dollars. Please provide us with the realized gain/loss report from your broker.
Other Income (for instance, director’s fees, retirement, social security, alimony, debt forgiveness, gambling winnings, etc.):
Description/Payor / Location of other income / Amount of income / Explanation$
$
Please indicate if you sold your principal residence/former principal residence this year ____Yes ___ No
DEDUCTIONS
Describe deductions, the amounts paid, and dates paid. If a deduction does not apply to you, you can leave blank or indicate N/A.
39. Medical and Dental Expenses (please note these need to exceed 7.5% of gross Income to receive any benefit). You may also include medical/dental insurance premiums. US$______
40. Interest on Home Mortgage in USA (please advise if you have mortgages on more than 2 homes). US$______
41. Interest on Mortgage outside the US (state name and address of entity to which you paid foreign mortgage payments). Also indicate currency: ______
42. Interest on any other mortgage such as a “second mortgage/home equity loan”: ______
Please describe what used for or any other details: ______
43. Indicate if you refinanced a mortgage this year: _____ Yes ______No
44. Auto License Fees US$______
45. Sales Tax paid to a U.S. state – if any (this generally only applies to residents in a non income tax state):
US$______
46. Property Taxes on U.S. property (indicate which property if more than one): Please provide copy of property tax bill if a California property. US$______
47. Property Taxes on Foreign property (describe property): US$______
48. U.S. Charitable contributions to U.S. Charities - only for which you have proper documentation (provide detailed information about donations): ______
49. Investment Interest Expenses (such as a margin loan): US$______
50. Other Investment Expenses (describe): US$______
51. Tax Preparation Fees paid during the tax year US$______
52. Provide Details of any moving or storage expenses:______
53. Interest on Student Loans (indicate who for) ______
54. Tuition and other Educational expenses (provide details): ______
OTHER QUESTIONS/INFORMATION
55. Foreign Taxes paid on income other than wages such as on foreign
interest, dividends, rents, royalties, etc. – this does not include VAT. ______
56. Rolled over foreign tax credits from previous years (OR provide
schedule from prior year return) ______
57. Do you file a non-resident state income tax return in any state? If so, why? ______
58. Was any of your income received this year from stock options, deferred compensation plans, or other executive plans? ______
59. Are you covered by a foreign pension plan (not U.S. qualified)? Contributions and earnings in these plans may be taxable, and may require special reporting forms each year. Most employer contributions to these plans are considered salary income. ______
60. Investments in a foreign mutual fund (not traded on the U.S. stock market) can be subject to a very complicated and adverse tax calculation in the U.S. It is important we are notified of these investments so we can do the required calculations. Do you have investments in foreign (non-US) mutual funds which are not part of your US brokerage account? ______Yes ______No
61. Do you make contributions to any retirement plan (other than 401(k)) or want to? Are you interested in converting to a ROTH IRA, if eligible? Check all that apply and provide relevant information / ______I make contributions______My spouse contributes
______I am interested in making contributions or _____ Converting to a Roth
62. Do you want to have any tax refund directly deposited into your U.S. checking or savings account? If so, please provide the following banking information. In certain cases your tax balance due (if any) can be automatically withdrawn from your bank account when we e-file your
Return and only after you confirm agreement of tax due. If you are interested in electronic payment of tax due check here ______. / ______Name of Bank
______Routing # (9 digit number on bottom left of check)
______Acct Number ____ Checking ____Savings
63. Did you make any quarterly estimated tax payments for federal or state? If so, please provide details:______
64. Please list any other items of income or expense that you feel might affect your U.S. taxes, or any other information you want to provide: ______
IMPORTANT - ADDITIONAL FORMS WHICH MAY BE REQUIRED
A. The IRS requires special forms be filed by any U.S. Taxpayer who owns all or part of a foreign corporation, foreign LLC (or equivalent), foreign LLP, foreign partnership, or foreign trust. If you fail to file these forms, you will be subject to substantial penalties if it is ever discovered that you should have filed those forms. Please indicate here if you are an owner of a foreign corporation or trust and we will send you an additional questionnaire for the information required to be reported in those forms.
Yes _____ No _____ If Yes, please describe: ______
B. FOREIGN FINANCIAL ASSET REPORTING REQUIREMENT: There is a reporting requirement as part of your tax return (first instituted for the 2011 tax year) for individuals who have “Specified Foreign Financial Assets” in excess of certain levels. Specified Foreign Financial assets include the following: